Tackling Adolescent Obesity: An Examination of Treatment Affordability and Efficiency

A recent study published in 2023 investigated the cost-effectiveness of various anti-obesity medications for adolescents ( 1 ). Given the rising prevalence of childhood and teen obesity, identifying affordable and efficient treatments is crucial.

The Study

Researchers from Columbia University and the University of Minnesota developed a microsimulation model to evaluate costs, health outcomes, and body mass index (BMI) changes in 100,000 simulated 15-year-old patients over five years. It compared two interventions:

  • Lifestyle interventions alone focused on diet and exercise
  • Lifestyle counseling combined with two weight loss medications: phentermine/topiramate and semaglutide

The goal was to analyze and compare the costs, health impacts, and BMI changes between these two approaches to treating adolescent obesity. The microsimulation model allowed the researchers to conduct a robust evaluation by generating a large virtual patient population with detailed individual characteristics over time.

Lifestyle Modifications Offer Best Short-Term Value

The analysis revealed that lifestyle modifications, such as diet and exercise coaching, were the most cost-effective option at 13 months and 2 years, with an estimated cost of $13,000 per quality-adjusted life year (QALY) gained.

Although the model predicted minimal BMI reduction, other treatment options were considered less cost-effective due to their higher cost than modest BMI reductions.

Phentermine/Topiramate Emerges as Cost-Effective Option

At five years, maximum-dose phentermine/topiramate became the most cost-effective choice, with an estimated cost of $57,000 per QALY gained.

This treatment resulted in a 7-8% reduction in BMI from baseline. While not as effective as semaglutide, phentermine/topiramate better balanced BMI reduction and cost-effectiveness.

Semaglutide Shows Promise, but Prohibitive Costs

Semaglutide demonstrated superior weight loss efficacy, decreasing BMI by 16-17% over five years.

Unfortunately, its high cost, exceeding $1.1 million per QALY gained, makes it less cost-effective than phentermine/topiramate for teenage patients.

Call for Long-Term Clinical Trials

Although the computer simulation provides valuable insights into short-term cost-benefit tradeoffs, the researchers stressed the importance of conducting longer clinical trials to assess weight loss maintenance and overall health impact into adulthood. Such studies will offer a clearer understanding of the long-term cost-effectiveness of these treatments.


This study highlights the importance of considering both cost and effectiveness when evaluating teen anti-obesity treatments.

While lifestyle modifications are the most cost-effective short-term solution, maximum-dose phentermine/topiramate might provide the best balance of BMI reduction and value for money over five years.

Further research should investigate whether newer drugs like semaglutide can become cost-effective options over patients’ lifetimes.

  1. Lim, F., Bellows, B. K., Tan, S. X., Aziz, Z., Woo Baidal, J. A., Kelly, A. S., & Hur, C. (2023). Cost-Effectiveness of Pharmacotherapy for the Treatment of Obesity in Adolescents. JAMA Network Open, 6(8), e2329178. https://doi.org/10.1001/jamanetworkopen.2023.29178